Short Attention Span Summary

Pus + Old = FailThere is a push to treat more skin infections on an outpatient basis. These authors found that for each decade of life, the odds of treatment failure for purulent skin infections increased by 43%. Patients over age 65 had nearly 4 times the odds of failure of initial ED treatment than younger patients.

5Department of Pediatrics and Division of Global Health, Massachusetts General Hospital, Boston, MA, United States.

Abstract

OBJECTIVE:

Current Infectious Disease Society of America (IDSA) guidelines for the management of purulent skin or soft tissue infections do not account for patient age in treatment recommendations. The study objective was to determine if age was associated with outpatient treatment failure for purulent skin infection after adjusting for IDSA treatment guidelines.

METHODS:

We conducted a multicenter retrospective study of adult patients treated for a purulent skin infection and discharged home from four emergency departments between April and September 2014. Patients were followed for one month to assess for treatment failure (defined as need for a change in antibiotics, surgical intervention, or hospitalization). We used multivariable logistic regression to examine the role of patient age on treatment failure adjusting for demographic variables (gender, race), comorbidities and severity of infection.

Elderly patients with purulent skin infections, whose providers followed the 2014 IDSA guidelines, were more likely to fail initial treatment than younger patients. This study suggests that there is a need to re-evaluate treatment guidelines in elderly patients.